School of Nursing, The University of Auckland, Auckland, New Zealand.
Auckland District Health Board, Auckland, New Zealand.
Health Soc Care Community. 2019 Jul;27(4):917-925. doi: 10.1111/hsc.12709. Epub 2019 Feb 6.
It is well documented that Health care assistants (HCAs) provide the most hands-on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person-centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end-of-life, identifies the skills required for their work and examines the education provided against these skills. Semi-structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person-centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de-escalation skills, both verbal and non-verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem.
有大量文献记载，医疗保健助理（HCAs）为养老院的居民提供最直接的护理，并在为痴呆症患者提供护理方面发挥着关键作用。在过去的 25 年中，以患者为中心的护理理念已成为首选的护理方法，这意味着鼓励 HCAs 与居民建立深厚的关系。本文报告了 HCAs 在照顾临终患者方面的经验，确定了他们工作所需的技能，并针对这些技能检查了所提供的教育。在新西兰的 49 家机构（n=34）中进行了半结构化访谈，并对数据进行了主题分析，旨在批判性地审查满足其在以患者为中心的环境中的需求的医疗保健助理教育的充分性。结果证实，这些技能包括传统的护理任务（洗澡、喂食、如厕和穿衣），但越来越重要的沟通和缓解技能，包括口头和非口头技能，已成为他们护理技能的核心。所提供的教育并没有充分将重点转移到包括这些更复杂的技能。需要提供教育，承认其角色的复杂性增加。此外，还需要对机构提出挑战，重新考虑 HCAs 在机构护理团队中的地位。
